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.+ CERTIFICATE OF <br />LIABILITY fNSURANC <br />2/23/2017D/YYYY) <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, <br />EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />Santa Ana, CA 92701 <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to <br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the <br />certificate holder in lieu of such endorsement(s). <br />EACH OCCURRENCE $ 10 , 000 ,_000 <br />PRODUCER <br />EMPIRE WEST INS SERVICES INC <br />4125 Temescal St Ste C <br />MED EXP (Anyoneperson) $ 5 000 <br />CONTACTJeff Kortan <br />NAME <br />PHONE FAX <br />(916) 967-1130 (A/C No (888)204-4268 <br />E-MAIL <br />E-MAIL s:3off@empirewest.net <br />ADDRFair <br />Oaks, CA 95628 <br />OF04110 <br />X Contractual Liability <br />INSURERS AFFORDING COVERAGE NAIC# <br />INSUREFA, Everest Indemnity Ins. Co. 10851 <br />INSURED National Demolition Contractors <br />INSURER B: Century—National Ins. Co. 26905 <br />1536 W. 25th Street, #248 <br />3/26/2017 <br />:SUREEg, Landmark .American Ins. Co. 33138 <br />San Pedro, CA 90732 <br />INSURER D: <br />(310)732-1991 <br />I INSURER <br />(310) 420-2766 JCell <br />COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />LTR TYPE OF INSURANCE INSD WVD POLI NU BER POLICY EFF <br />MMAPOLICY <br />O/ / YYY LIMITS <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />X COMMERCIAL GENERAL LIABILITY <br />CLAIMS -MADE l OCCUR <br />� -- <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana, CA 92701 <br />AUTHORIZED REPRESENTATIVE <br />EACH OCCURRENCE $ 10 , 000 ,_000 <br />117P177 I Z5 PrM 1177— <br />_ aOcci a ce $ loo 000 <br />MED EXP (Anyoneperson) $ 5 000 <br />X Pollution Liability <br />X Contractual Liability <br />PERSONAL&ADVINJURY $10,000,000 <br />A <br />EF4ML05833-161 <br />3/26/2016 <br />3/26/2017 <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY ® PES 1:1 LOC <br />GENERAL AGGREGATE $10,000,000 <br />PRODUCTS - COMP/OP AGG $1010001000 <br />Q ER: <br />CGL Deductible $ 5,000 <br />AUTOMOBILE LIABILITY <br />COMBINED SINGLE LIMIT <br />Ea accident) $ r r <br />BODILY INJURY (Per person) $ <br />B <br />XANYAUTO <br />ALLOWNED SCHEDULED <br />AUTOS AUTOS <br />BAP0183212 <br />9/17/2016 <br />9/17/2017 <br />BODILY INJURY (Per accident) $ <br />X HIRED AUTOS ,X NON -OWNED <br />AUTOS <br />PROPERTY DAMAGE $ <br />e cce <br />Comp/Coll Ded. $$50071,000 <br />C <br />C <br />JX <br />UMBRELLA LIAB <br />E <br />EXCESS LIAR <br />X <br />OCCUR <br />CLAIMS -MADE <br />LHA240807 <br />8/11/2016 <br />/26/2017 <br />EACH OCCURRENCE $ 5,000,000 <br />_ <br />AGGREGATE •• $ 5,000,000 <br />DED RE E TION$ <br />$ <br />WORKERS COMPENSATION <br />EMPLOYERS' LIABILITY Y N <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />OFFICER/MEMBER EXCLUDED? <br />N/A <br />ER <br />PER OTH- <br />STATUTE ER <br />E.L. <br />ELEACH ACCIDENT $ <br />E.L. DISEASE- EA EMPLOYEE $ <br />(Mandatory in NH) <br />If yes, describe under <br />DESCRIPTION OF OPERATIONS below <br />I <br />I <br />I <br />E.L. DI EASE - POLICY LIMIT <br />Professional Liability <br />A <br />(Claims Made Form) <br />EF4ML05833-161 <br />3/26/2016 <br />3/26/2017 <br />Limits included in the above <br />3/26/2012 Retro Date <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule,may be altachedif more space is required) <br />Certificate Holder: City of Santa Ana, its officers, employees, agents, volunteers and <br />representatives, are named as Additional Insured as respects all insureds operations <br />per written contract. <br />RE: Agreement entered on February 21, 2017. <br />01f,11111 -J!, <br />CERTIFICATE HOLDFR <br />(-.ANI(-.Fl I AT!ON d <br />City of Santa Ana <br />20 Civic Center Plaza <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ROSS Amex (M--36) <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />Santa Ana, CA 92701 <br />AUTHORIZED REPRESENTATIVE <br />© 1988-2013 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2013/04) The ACORD name and logo are registered marks of ACORD <br />